What happens if sertraline (selective serotonin reuptake inhibitor) is stopped suddenly?

From the Guidelines

Suddenly stopping sertraline is not recommended as it can cause withdrawal symptoms known as SSRI discontinuation syndrome, which may include dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation 1. When considering stopping sertraline, it is essential to understand the potential risks associated with its discontinuation.

• The symptoms of SSRI discontinuation syndrome can be severe and may last for several weeks.
• These symptoms occur because the brain has adapted to the increased serotonin levels from the medication and needs time to readjust when the medication is reduced or stopped.
• To minimize the risk of withdrawal symptoms, sertraline should be gradually tapered under medical supervision, typically over 2-4 weeks depending on the current dose and how long the patient has been taking it 1. Some key points to consider when tapering sertraline include:
• Starting with a subtherapeutic dose as a “test” dose to assess the patient's response to the medication.
• Gradually increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals for shorter half-life SSRIs like sertraline 1.
• Systematic assessment of treatment response using standardized symptom rating scales to monitor the patient's progress and adjust the tapering schedule as needed. It is crucial to work with a healthcare provider to create a personalized tapering schedule to ensure a safe and effective discontinuation of sertraline. Never stop taking sertraline on your own, even if you feel better, as this could lead to withdrawal symptoms or a return of the condition being treated.

From the FDA Drug Label

Do not stop sertraline without first talking to your healthcare provider Stopping sertraline too quickly may cause serious symptoms including: anxiety, irritability, high or low mood, feeling restless or changes in sleep habits headache, sweating, nausea, dizziness electric shock-like sensations, shaking, confusion During marketing of sertraline and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e. g. paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania.

If sertraline is stopped suddenly, it may cause serious symptoms, including:

• Anxiety
• Irritability
• Mood changes
• Sleep disturbances
• Headache
• Sweating
• Nausea
• Dizziness
• Electric shock-like sensations
• Shaking
• Confusion It is recommended to gradually reduce the dose rather than stopping abruptly to minimize the risk of these symptoms 2 2.

From the Research

Stopping Sertraline Suddenly

If sertraline, a selective serotonin reuptake inhibitor (SSRI), is stopped suddenly, several symptoms may occur due to discontinuation syndrome.

• The symptoms can be somatic, including:
  • Dizziness and light-headedness
  • Nausea and vomiting
  • Fatigue, lethargy, myalgia, chills, and other flu-like symptoms
  • Sensory and sleep disturbances
• Psychological symptoms may also occur, such as:
  • Anxiety and/or agitation
  • Crying spells
  • Irritability

Managing Discontinuation Symptoms

To minimize these symptoms, gradual tapering of the medication is recommended 3, 4. This approach can help reduce the severity and frequency of discontinuation symptoms.

• In some cases, symptoms may be mild and self-limiting, but they can be distressing and may lead to missed work days and decreased productivity 3.
• If symptoms are severe, it may be necessary to reinstitute the dosage of the original antidepressant and slow the rate of taper 3.

Importance of Gradual Tapering

Gradual tapering is crucial in managing discontinuation symptoms, especially for SSRIs with shorter half-lives like sertraline 3, 4.

• A study reported a case of orthostatic hypotension induced by sertraline withdrawal, highlighting the importance of careful discontinuation 5.
• The Discontinuation Consensus panel defined the SRI discontinuation syndrome, which is distinct from the classic withdrawal syndrome associated with alcohol and barbiturates 4.

Clinical Evidence

While there is evidence on the effectiveness of sertraline in managing depression 6, 7, the studies also emphasize the need for careful discontinuation to minimize symptoms 3, 4, 5.

• A pragmatic, double-blind, placebo-controlled randomized trial found that sertraline led to reduced anxiety symptoms, better mental health-related quality of life, and self-reported improvements in mental health 6.
• Another study highlighted the importance of sertraline in the management of depression, with a favorable pharmacologic profile and minimal side effects 7.